End of life care involves detailed attention to the individual’s physical, emotional and spiritual needs. Most people will die in a skilled nursing facility, a hospital or in their own home. Regardless of the setting, no one wants to see their loved one suffering tremendous pain, and similarly, no one wants to experience significant pain that accompanies a number of diseases like cancer, multiple sclerosis and Parkinson’s disease.
Types of Pain at End of Life
Delivering appropriate care to an individual who is experiencing pain at the end of his or her life involves understanding the type of pain involved. Many experts on the topic agree that there are at least seven different types of pain including acute, chronic, somatic, visceral, neuropathic, breakthrough, and total pain.
Acute pain is time-limited and generally responds to analgesic medications like Tylenol or Motrin. Chronic pain, on the other hand, lasts at least three months, and must be managed to preserve quality of life. Two goals involved in treating chronic pain include reducing related symptoms (i.e. inflammation) and restoring maximal functioning.
Somatic pain is more localized and is expressed as a deeply aching pain that commonly occurs in arthritic joints, osteopathic lesions, fractures and abscesses. Visceral pain is expressed differently than somatic pain and is characterized as deep pressure, cramping, spasms, and squeezing pain. This type of pain is usually accompanied by other symptoms including nausea, sweating, and vomiting.
Neuropathic pain results from damage to the peripheral nervous system, the central nervous system, or both. It is described as sharp, electric, burning pain. People diagnosed with cancer, diabetes, HIV, multiple sclerosis and stroke frequently complain of this type of pain.
Breakthrough pain is also called “Incident” pain and refers to a temporary increase in pain from acute or chronic pain levels. It also refers to the worsening of pain at the end of a regularly scheduled analgesic dose. Healthcare professionals need to be prepared to effectively monitor for breakthrough pain and manage it.
Total pain was first described by Dr. Cicely Saunders, the founder of modern-day hospice care. She conceptualized pain associated with the dying process as total pain that involves four components:
- Physical noxious stimuli
- Affect or emotional discomfort
- Interpersonal conflicts
- Non-acceptance of one’s own dying
Dr. Saunders was the first to explain that pain at the end of life is much more than, and is never purely, physical. At the end of life, people experience pain emotionally, and sometimes this kind of pain can be worse than the physical kind. Some people are spiritually tormented at the end of their lives and experience harsh emotions like regret, loneliness, and emptiness. Some will struggle to find meaning and purpose in their lives.
Final Words on Managing Pain at the End of Life
Caring for someone at the end of his or her life takes a great deal of compassion, skill, and attention to detail. Pain may be a significant part of the dying process and will need to be recognized and effectively managed for a better quality of death. In order to treat pain, the healthcare professional needs to be aware of the different types of pain the individual may be experiencing. All pain types are not alike and will not respond to the same treatment.
(NOTE: Interested in learning more about Hospice? Checkout my Hospice CEUs on CEU Academy and try a FREE CEU today!)
More About Hospice
- Barriers to Effective Pain Management in Senior Care
- What David Bowie Taught Me About Death
- Traumatic Loss: What it is and How to Recover
- When is it Time for Hospice?
- Talking to Families about Hospice
- Pain Management
- On Grief, Mourning and Bereavement
- Hospice 101
- Death and Dying in Long-Term Care